1. Field of the Invention
This invention relates generally to surgical devices which facilitate the suturing of tissue, and particularly conduit suturing.
2. Description of the Prior Art
Most body conduits are generally cylindrical in configuration and have a circular cross-section. When it is desirable to suture such a conduit, typically for attachment to another body conduit, the sutures are placed around the circumference of the conduit in order to maintain the patency of its lumen or channel. This type of attachment is commonly referred to as an anastomosis. It differs from straight line suturing in that each suture has a different orientation which is based on its position around the cross-sectional circumference of the conduit. It can be appreciated that some of the sutures are easily made from on top of the conduit, while others are more difficult to complete as they are beneath the conduit.
The complexity of anastomosis attachment is dramatically represented in a surgical procedure referred to as a radical retropubic prostatectomy. This is a well established surgical procedure for patients with localized prostatic carcinoma. In its broadest sense, this surgical procedure requires removal of the prostate gland after severing the gland from the bladder neck and the urethra. It is the attachment of the urethra stump to the bladder neck which is particularly difficult. This difficulty is complicated by the tendency of the urethral stump to retract into adjacent tissue. As a result, considerable time and effort must be extended to re-expose the urethra stump and begin the re-anastomosis procedure. Further complicating this procedure is the fact that the urethral stump is hidden beneath the pubic bone thus requiring that the surgeon work at a difficult angle and in positions that are uncomfortable and limiting.
Various devices have been proposed for facilitating this procedure. In U.S. Pat. No. 4,911,164, Roth discloses the suture guide with a curved distal portion. This distal portion has a plurality of exterior axial grooves which can be used to align and guide a curved needle and attached suture. In order to drive the urethral stump to an accessible position, the device is provided with a plurality of outwardly extendable members which engage the lumen of the urethra. These members make it possible to push the urethral stump into approximation with the bladder neck. The aggressive nature of these extended members has caused considerable damage to the urethral stump.
U.S. Pat. No. 5,047,039 issued to Avant et al. discloses a surgical device for the ligation of dorsal vein and subsequent anastomosis. This device contains a pair of enclosed needles with attached suture which may be driven from the shaft of the device into adjacent tissue. The device does not facilitate placement of a plurality of sutures around an enlarged conduit such as the urethral stump. Nor does it in any way facilitate advancement of the urethral stump to increase its exposure. Various other needle guides, sounds and other suturing devices are disclosed in the following patents:
______________________________________ 2,547,758 3,669,099 4,848,367 3,168,092 4,352,926 4,905,693 3,254,651 4,553,543 4,994,066 3,626,947 4,752,024 5,053,043 4,873,977 ______________________________________
In general, none of these devices of the prior art addresses the problem associated with re-anastomosis of the urethral stump to the bladder neck. Nor do they disclose any device which can accurately position a needle and suture combination for use at or near the severed end of a body conduit. Importantly, these devices are not flexible and accordingly do not enable the surgeon to assume the best operative position.